EDI Enrollments Specialist

📋 Description

• • Join Candid Health Inc. as an EDI Enrollments Specialist and play a pivotal role in ensuring seamless and efficient healthcare revenue cycle management for our clients. In this remote position, you will be instrumental in configuring and managing Electronic Data Interchange (EDI) and Electronic Funds Transfer (EFT) enrollments, directly impacting our ability to process claims and payments accurately and swiftly. Your expertise will be crucial in navigating the complexities of payer portals and clearinghouses, ensuring that our clients' billing operations run as smoothly as possible.
• • Your primary responsibility will involve the meticulous preparation and submission of applications to configure Electronic Data Interchange (EDI) for claims and Electronic Remittance Advice (ERA). This process requires a keen eye for detail and a thorough understanding of the requirements set forth by various clearinghouses and payer portals. You will be the go-to person for ensuring these critical connections are established correctly, laying the groundwork for efficient claims processing.
• • Furthermore, you will be tasked with preparing and submitting applications to configure Electronic Funds Transfer (EFT) with payers. This aspect of the role is vital for ensuring timely and secure payment processing, reducing administrative overhead, and improving cash flow for our clients. You will manage the entire EFT setup process, from initial application to final confirmation.
• • A significant part of your role will be to proactively initiate investigations with payers when provider enrollment denials or errors occur. This requires a strong investigative mindset, the ability to analyze denial reasons, and the skill to effectively communicate with payer representatives to resolve issues. You will be responsible for troubleshooting and rectifying any discrepancies that hinder the enrollment process.
• • You will be responsible for meticulously reviewing all correspondence received from payers. This includes understanding the nature of the communication, identifying necessary actions, and implementing resolutions in a timely manner. Your ability to interpret payer communications and take appropriate steps will be key to maintaining smooth operations.
• • Acting as a critical liaison, you will bridge the gap between our Revenue Cycle Management (RCM) department and the Strategy & Operations team. This collaborative effort will involve discussing, investigating, and resolving complex enrollment tasks, ensuring alignment and efficient problem-solving across departments.
• • You will engage directly with our customers, providing them with excellent written and verbal communication. Building and maintaining strong customer relationships through clear, concise, and helpful interactions is paramount. You will be a trusted point of contact for their enrollment-related inquiries.
• • Maintaining up-to-date and accurate enrollment records within the Candid Health product is a core function of this role. You will ensure that all data is entered correctly and kept current, providing a reliable source of information for internal teams and external stakeholders.
• • To ensure the highest level of service and efficiency, you will be expected to meet and maintain Key Performance Indicators (KPIs) and metrics for both production volume and quality of work. Continuous improvement and adherence to performance standards are essential.
• • You will be responsible for maintaining a comprehensive and up-to-date working knowledge of all workflows, systems, and tools utilized within the department. This includes staying abreast of any changes or updates to ensure optimal performance.
• • Adherence to HIPAA guidelines is non-negotiable. You will ensure all activities are conducted in compliance with patient privacy and data security regulations, safeguarding sensitive healthcare information.
• • This role offers a unique opportunity to contribute significantly to the operational success of Candid Health and its clients, fostering a more efficient and effective healthcare ecosystem.